Age / Sex : 11 / F

Chief complaint: pain after trauma

What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(답안은 한 개만 보내주시기 바랍니다)

Courtesy: 채지원 (Jee won Chai), 서울특별시보라매병원 (SMG-SNU Boramae Medical Center)

Hypertrophied anterior tubercle of transverse process (A Variant)

Discussion

Findings:

Articulation of elongated of anterior tubercles of transverse process of C5 and C6

Associated incomplete segmentation (disc space narrowing and deformity of vertebral body)

Differential Diagnosis: Osteochondroma, Avulsion Fracture

Diagnosis: Hypertrophied anterior tubercle of transverse process (A Variant)

Discussion:

Anterior tubercle of transverse process is not a true vertebral element, but a costal element in cervical vertebrae. There are a few case reports of enlarged anterior tubercles of adjacent vertebrae forming an articulation. Incomplete segmentation can be associated with this variant. It is a phenomenon similar to partial sacralization at the lumbosacral junction and bridging of posterior ribs. It is important not to mistake this variant for pathologic condition.

References:

Y. Applbaum, M.D., P. Gerard, M.D., and D. Bryk, M.D. Elongation of the Anterior Tubercle of a Cervical Vertebral Transverse Process: An Unusual Variant Skeletal Radiol (1983) 10: 265-267.

Shigeru Ehara. Relationship of elongated anterior tubercle to incomplete segmentation in the cervical spine. Skeletal Radiol (1996) 25:243–245.